Update: Use 59 Modifier for increased multiple birth reimbursements

Summary

We recently sent you a communication notifying you that Anthem increased reimbursements as of November 1, 2013, for multiple births (for example, twins, triplets, etc.) occurring via the same delivery method billed with a 51 modifier. That communication was incorrect. To receive the higher reimbursement for multiple births, you will need to bill with the 59 modifier and not with the 51 modifier as previously instructed. When you bill with a 59 modifier and use the diagnosis and procedure code combinations below for multiple births with the same delivery method (for example, vaginal to vaginal, cesarean section to C-section), we will reimburse at 125% of the Nevada Medicaid fee schedule.

What this means to you

No immediate action necessary — Pass this information to your office staff.

Why is this change necessary?

An earlier communication on this topic incorrectly listed the affected modifier as 51. We are correcting that mistake and informing you that the correct modifier to use when submitting multi delivery claims is 59.

Do I need to refile claims?

Previously submitted claims affected by this update may be resubmitted for review and, if applicable, adjusted reimbursement.

What is the impact of the change on coding?

Obstetrical providers who bill using the 59 modifier for same-delivery-method multiple births will be reimbursed at 125% of the Nevada Medicaid fee schedule.

Codes affected by this change

Billing examples

Say you deliver twins (same method) for a member. To receive appropriate reimbursement, proper billing entails:

• Twin A: vaginal delivery code with postpartum care and no modifier; one unit — will reimburse 100% of Nevada Medicaid fee schedule
• Twin B: vaginal delivery only code with a 59 modifier; 1 unit — will reimburse 25 percent of Nevada Medicaid fee schedule

What is the impact of the change on medical record review requirements?

Medical record review is not required with the use of the 59 modifier for multiple deliveries (for example, twins, triplets). The modifier 22 for increased procedural services requires medical records and should not be used to be reimbursed for multiple births using the same delivery method at 125% of the Nevada Medicaid fee schedule.

What if I need help?

If you have questions about this communication, received this communication in error or need help with anything else, contact your provider relationship management representative or call Provider Services at 844-396-2330.